Disarray of Injury/Regeneration Homeostasis in Smoking-Induced COPD

慢性阻塞性肺病(COPD)是导致肺部残疾和死亡的主要原因，主要由吸烟引起。最初的病理改变发生在小气道和中央小叶肺泡，慢性炎症和伴随的局部表达的蛋白水解酶、氧化剂、细胞凋亡和其他炎症介质能够损伤呼吸道和肺泡。Weill Cornell COPD SCCOR的基本主题是，COPD的临床表型是当肺的再生过程不再能够维持正常的肺结构和功能时，吸烟导致的对呼吸道/肺泡的持续损伤以及炎性宿主对吸烟的反应。围绕这一主题，拟议的SCCOR有5个项目，由6个核心支持。四个项目是临床项目(项目1、2、4、5)，都集中在COPD患者肺特定组成部分的基因表达上。一个项目是临床前(项目3)，重点是肺再生。核心A、B提供支持人类研究对象的服务，核心C、D提供生物材料分析服务，核心E专注于培养临床研究技能的教育，核心F提供行政支持。所有的项目都使用了新颖的策略来评估潜在的主题。项目1基于临床观察，即HIV-1+吸烟者早期肺气肿发病率高，吸烟史有限，建议研究肺泡巨噬细胞的基因表达，以帮助了解哪些介质在介导肺破坏中最重要。项目2利用了对果蝇和发育中的小鼠胚胎的研究知识，即Notch途径是分化的“守门人”，以帮助揭开COPD患者呼吸道上皮中观察到的异常分化模式。项目3应用于肺切除后快速肺再生的小鼠模型，以破译CXCR4+VEGFR1+血管生成前体在肺血管重建中的作用。项目4研究创伤诱导的呼吸道上皮再生后稳定状态和长期用于纤毛形成的基因，以评估错乱基因表达在慢性阻塞性肺疾病纤毛功能异常中的作用。项目5利用一种新开发的策略重复采样人类小气道上皮细胞，以确定与COPD发病机制有关的多种基因的异常表达，并使用这种异常的“小气道分子信号”来评估戒烟、气雾剂皮质类固醇治疗或白三烯途径抑制剂治疗对COPD相关分子通路的影响。

Chronic obstructive lung disease (COPD), a leading cause of pulmonary disability and death, is caused mainly by cigarette smoking. The initial pathologic changes are in the small airways and central lobular alveoli, with chronic inflammation and concomitant local expression of protease, oxidant, apoptotic and other inflammatory mediators capable of injuring the airways and alveoli. The theme underlying the Weill Cornell COPD SCCOR is that the clinical phenotype of COPD evolves when the regenerative process of the lung are no longer capable of maintaining normal lung structure and.function under the persistent injury to airways/alveoli caused by smoking and the inflammatory host response to smoking. With this theme, the proposed SCCOR has 5 projects supported by 6 cores. Four projects are clinical (Projects 1, 2, 4, 5), all focused on gene expression of specific components of the lung in patients with COPD. One project is pre-clinical (Project 3), focused on lung regeneration. Cores A, B provide services to support the study of human subjects, Cores C, D provide services for analysis of biologic materials, Core E is focused on education for developing clinical research skills, and Core F provides administrative support. All of the projects use novel strategies to assess the underlying theme. Project 1, based on the clinical observation that smokers that are HIV-1+ have a high incidence of emphysema at an early age and limited smoking history, proposes to study gene expression in alveolar macrophages to help understand which mediators are the most important in mediating lung destruction. Project 2 exploits the knowledge from studies of Drosophila and the developing murine embryo that the Notch pathway is a "gatekeeper" for differentiation to help unravel the abnormal pattern of differentiation observed in the airway epithelium in COPD. Project 3 applies to the murine model of rapid postpneumonectomy lung regeneration to decipher the role of CXCR4+VEGFR1 + hemangiogenic precursor to lung revascularization. Project 4 studies genes used for ciliogenesis in the steady state and over time after wounding-induced airway epithelial regeneration to assess the role of deranged gene expression in abnormal cilia function in COPD. Project 5 utilizes a newly developed strategy to repetitively sample the human small airway epithelium to define abnormal expression of multiple categories of genes implicated in the pathogenesis of COPD, and uses this abnormal "small airway molecular signature" to assess the impact of smoking cessation, aerosol corticosteroid therapy, or leukotriene pathway inhibitor therapy on molecular pathways relevant to COPD.